EP3471819B1 - Dispositif et méthode de placement de conducteurs et de conduits - Google Patents

Dispositif et méthode de placement de conducteurs et de conduits Download PDF

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Publication number
EP3471819B1
EP3471819B1 EP16905653.8A EP16905653A EP3471819B1 EP 3471819 B1 EP3471819 B1 EP 3471819B1 EP 16905653 A EP16905653 A EP 16905653A EP 3471819 B1 EP3471819 B1 EP 3471819B1
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EP
European Patent Office
Prior art keywords
lead
distal end
suction foot
end portion
foot portion
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EP16905653.8A
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German (de)
English (en)
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EP3471819A1 (fr
EP3471819A4 (fr
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Subhajit DATTA
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Individual
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Individual
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Publication of EP3471819A4 publication Critical patent/EP3471819A4/fr
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3468—Trocars; Puncturing needles for implanting or removing devices, e.g. prostheses, implants, seeds, wires
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00238—Type of minimally invasive operation
    • A61B2017/00243—Type of minimally invasive operation cardiac
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/003—Steerable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/30—Surgical pincettes without pivotal connections
    • A61B2017/306—Surgical pincettes without pivotal connections holding by means of suction
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B2017/348—Means for supporting the trocar against the body or retaining the trocar inside the body
    • A61B2017/3482—Means for supporting the trocar against the body or retaining the trocar inside the body inside
    • A61B2017/3484—Anchoring means, e.g. spreading-out umbrella-like structure
    • A61B2017/3488—Fixation to inner organ or inner body tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/02—Details
    • A61N1/04—Electrodes
    • A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
    • A61N1/0587—Epicardial electrode systems; Endocardial electrodes piercing the pericardium

Definitions

  • the present invention relates to devices used in thoracoscopic lead placement, and in similar surgical techniques.
  • Heart failure is a condition in which the heart's pumping power is weaker than normal. With heart failure, blood moves through the heart and body at a slower rate, and pressure in the heart increases. A delay between the contraction of the right and left ventricles often occurs with heart failure, so the walls of the left ventricle are unable to contract synchronously.
  • Biventricular pacing also known as cardiac resynchronization therapy (CRT) utilizes a type of pacemaker that can pace both the septal and lateral walls of the left ventricle. 1 By pacing both the right and left ventricles, the pacemaker can resynchronize a heart. 1 Pavia SV, Wilkoff BL. Biventricular pacing for heart failure. Cardiol Clin. 2001 Nov;19(4):637-51 .
  • CTR cardiac resynchronization therapy
  • Candidates for CRT include patients with severe or moderately severe heart failure symptoms, delayed electrical activation of the heart (such as intraventricular conduction delay or bundle branch block), or those with a history of cardiac arrest or risk factors for cardiac arrest.
  • CRT improves symptoms of heart failure in about one third of patients who have been treated maximally with medications but still have severe or moderately severe heart failure symptoms. Another third of patients see an improvement in ejection fraction without any major change in symptoms and the last third of the patient population are not responsive to CRT.
  • CRT improves survival, quality of life, heart function, the ability to exercise, and helps decrease hospitalizations in select patients with severe or moderately severe heart failure.
  • CRT can help improve ejection fraction (volume of blood pumped out of the left ventricle) and when combined with an implantable cardiac defibrillator it can help protect against dangerous, fast heart rhythms. 2
  • Both CRT pacemakers and CRT defibrillators use a left ventricular pacing lead. 2 Bristow M, et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. 2004. N Engl J Med 350 (21): 2140-50 .
  • the CRT device and its leads can be implanted using an endocardial (transvenous) or epicardial (surgical) approach.
  • the endocardial approach is the most common method. A local anesthetic is given to numb the area. The leads are inserted through an incision in the chest and into a vein. Two leads are guided to the right atrium and right ventricle of the heart, while the third lead is guided through the coronary sinus (the venous system of the heart) to the left ventricle. The lead tips are attached to the heart muscle, while the other ends of the leads are attached to the pacemaker placed in a pocket created under the skin in the upper chest. When the endocardial approach is used, the hospital recovery time is generally 24 hours. The endocardial technique is technically challenging. In some cases, this technique may not be successful due to the size, shape or location of the vein(s). If the endocardial approach cannot be used or is unsuccessful, the epicardial approach is then attempted.
  • the epicardial approach is a less common method in adults, but more common in children.
  • the leads are placed under general anesthesia and guided to the heart with the aid of the fluoroscopy machine.
  • the locations of lead placement are identical to the endocardial approach.
  • the pulse generator is placed in a pocket created under the skin in the abdomen.
  • Standard predictors of operative complications apply, those being degree of heart failure, the surgical environment, diabetes and the duration of the procedure. Although with experience the procedure times reduce, even in the best hands implantation of the left ventricular lead may be time consuming, contributing to an increased infection risk. 3 3 Alonso. C, et al. Six year experience of transvenous left ventricular lead implantation for permanent biventricular pacing in patients with advanced heart failure: technical aspects. Heart. 2001;86(4):405-410 .
  • left ventricular lead insertion using the transvenous approach was introduced. 4
  • the precise location of the lead is ideally the mid left ventricular cavity in a lateral or posterolateral vein.
  • 5 The use of guiding catheters within the coronary sinus and the use of purpose-designed leads have increased success rates and ability to reach the target vessel. Some of these procedures may require the use of multiple types of catheters and guidewires, adding cost to this procedure. The requirement to position a lead in a branch of the coronary sinus and the techniques required to achieve this account for the additional complications and significant failure rate seen with biventricular pacing.
  • US 2007/239246 A1 describes a device adapted for placement of a lead at a target side, the device comprising a hollow lead guide, a lead, an elongated body with a lead receiving passageway, a lumen to provide suction, and a suction foot portion in fluid communication with said lumen.
  • the present invention includes devices that may be summarized as follows:
  • the present invention generally includes a lead or conduit placement device that is configured to permit the placement foot, such as a suction foot, to swivel to a desired position with respect to the target tissue, while the lead is releasably attached to the placement foot to permit it to be released from the placement foot after fixing the lead or conduit in the tissue.
  • Another aspect of the present invention is to arrange and configure the placement foot and lead (or lead-placing head portion) to be releasably attached.
  • the attachment should be sufficiently firm to allow the lead guide to transmit movement of the lead guide to the placement foot, so as to participate in the articulation of the placement foot in one direction, while being releasable through hand force to permit the lead to be separated from the placement foot after fixing the lead or conduit in the tissue.
  • the lead placement device of the present invention features a suction foot provided with a vacuum through a lumen extending through the device.
  • the device also includes an actuator that transmits movement of the lead guide to the placement foot in a second direction, so as to participate in the articulation of the placement foot.
  • the actuator in the preferred example may extend through the lumen. As an alternative, the actuator may reside outside the lumen.
  • One variation of the present invention is a lead placement device with a suction foot and releasable lead, optional releasable lead head, with an actuator.
  • This embodiment of the present invention includes a device adapted for the thoracoscopic placement of a lead at a target site on an epicardial surface of a heart (that being its principal, but non-exclusive mode of use), the device comprising: (a) a hollow lead guide having a lead guide distal end, and connected to a lead guide head at the lead guide distal end; (b) a lead extending through the hollow lead guide and having a lead distal end portion, the lead distal end portion extending from the lead guide head for contact with the epicardial surface of the heart, and releasably engaging the lead guide head; (c) an elongated body having a longitudinal axis, a proximal end portion and a distal end portion, and having a proximal inlet and a distal lead outlet for extending the lead guide head therethrough for contacting the lead with the epicardial surface of the heart, the elongated body comprising (1) a lead receiving passageway for receiving and conducting the lead guide head extending between the
  • the elongated body may be of any length, but typically will have a lead receiving passageway that has a length in the range of 10 cm to 40 cm for manual devices.
  • the elongated body be provided with a handle portion extending laterally therefrom for ease of manual use, though it will be appreciated that the invention may be adapted for robotic use.
  • Another preferred variant of the present invention is a lead placement device with a suction foot and releasable lead, optional releasable lead head, with an actuator that permits the suction foot and releasable lead, with optional releasable lead head, to be swiveled about a second axis.
  • the hollow lead guide additionally and preferably comprises a flexible member connecting the lead guide head to the lead guide distal end, and this flexible member may be any part of sufficient flexibility and resilience to permit the lead guide head and the suction foot to swivel as described herein.
  • the flexible member may be in the form of a metal or plastic spring, or equivalent metal or plastic structure.
  • the device be provided with a knob so as to permit the hollow lead guide to be rotated within the elongated body by hand, so as to rotate the lead guide head, to permit the user to twist the metal lead into place, especially where the distal end of the lead wire is in a corkscrew shape as is common.
  • the flexible member is of sufficient stiffness in the longitudinal direction (such as with a metal spring), that, upon movement of the hollow lead guide within the elongated body, the suction foot portion may be tilted about a second axis.
  • the suction foot portion has an engagement aperture aligned with the hollow lead guide, and wherein the lead guide head is adapted to releasably engage the engagement aperture.
  • This releasable engagement may be accomplished by any means acceptable to the device's use, such as through the use of light magnetic forces or adhesives, as well as through the use of mechanical arrangements involving light interferences fits, that are both of sufficient strength to permit the suction foot to be swiveled into the desired position, while allowing the suction foot and the balance of the device to be pulled free after final lead placement.
  • the suction foot portion defines an engagement aperture aligned with the hollow lead guide, and wherein the lead guide head is adapted to releasably engage the engagement aperture.
  • the suction foot portion may be of any shape, such as presenting a round, polygonal, star or ovoid foot print, though it is preferred that it have an arcuate footprint shape and comprise a plurality of air channels in fluid contact with the lumen, so as to be capable of providing suction to the suction foot portion.
  • This shape permits the lead to be more easily separated from the suction foot, and the balance of the device, after final lead placement.
  • the lead itself may be incorporated into supplementary structure for ancillary purposes such as electrical insulation and to be able to mechanically cooperate with the balance of the device and consistent with its function as described herein (such as by providing sleeves and flanges, etc.)
  • One such arrangement involves having the lead distal end be held by a lead guide head (typically of a polymeric material) so as to extend from the distal side of the lead guide head.
  • the device may also additionally comprise an interferant release collar attached to the lead distal end portion and disposed on the distal side of the suction foot portion, the interferant release collar being larger than the aperture. This allows more precise and oriented lead placement and to prevent accidental or premature retraction of the lead guide head, as described herein.
  • the actuator of the preferred embodiment of the present invention comprises a flexible member connecting the suction foot portion to the elongated body.
  • This flexible member may be any part of sufficient flexibility and resilience to permit the suction foot to swivel as described herein.
  • the flexible member may be in the form of a metal or plastic spring, or equivalent metal or plastic structure.
  • the actuator is in turn attached to a knob portion disposed on the proximal end portion, the knob adapted to move the actuator within the elongated body so as to tilt the suction foot about a first of the axes.
  • the actuator may be any part of sufficient flexibility and resilience to facilitate the movement of the suction foot to swivel as described herein.
  • the actuator comprise a wire attached to a knob portion disposed on the proximal end portion, the knob adapted to move the actuator within the elongated body so as to tilt the suction foot about a first of the axes.
  • the device may additionally comprise a source of vacuum suction in fluid communication with the lumen.
  • the source of vacuum suction in fluid communication with the lumen may be any source sufficient for operation of the device, and typically may be selected from the group consisting of a hand pump, or a syringe attached to the elongated body, or a motorized pump supplying vacuum suction to the lumen.
  • the device of the present disclosure may optionally include a plurality of lumens extending between the proximal inlet and the distal outlet.
  • the device of the present disclosure may also include a supplementary test lead extending from the lead guide head and through the elongated body.
  • Another aspect of the present disclosure is a lead placement device with a swiveling suction foot as represented, for instance, by the preferred examples described herein. It will be appreciated that this aspect of the invention may be constructed and used in other devices beyond that described in the preferred example herein.
  • This aspect of the present disclosure may be described as a device adapted for the thoracoscopic placement of a lead at a target site on an epicardial surface of a heart (though it may also be used with other tissues and other purposes, such as biopsy, stent or tubule placement, etc.).
  • the device comprises in general terms, (a) a hollow lead guide; (b) a lead extending through the hollow lead guide, the lead having a lead distal end portion; (c) an elongated body having a longitudinal axis, a proximal end portion and a distal end portion, and having a proximal inlet and a distal lead outlet, the elongated body comprising (1) a lead receiving passageway for receiving and conducting the lead distal end to the distal lead outlet, and (2) a lumen adapted to provide suction to the distal end portion; (d) a suction foot portion releasably attached to the lead distal end portion, and being in fluid communication with the lumen, the suction foot portion swivelably attached to the distal end portion such that the suction foot may be swiveled with respect to the longitudinal axis (the lead adapted to releasably engage the suction foot portion such that such engagement is of sufficient strength to maintain the position of the lead distal end portion as it
  • Still another aspect of the present invention is a lead placement device with suction foot and releasable lead head and lead with single actuator, wherein the device may be adapted for use with any tissue type and for the placement of any conduit type (such as conduit of electrical current or signals, or gas or liquid fluids conduits) for any medical or veterinary purpose.
  • the device may be adapted for use with any tissue type and for the placement of any conduit type (such as conduit of electrical current or signals, or gas or liquid fluids conduits) for any medical or veterinary purpose.
  • This device may be understood as being adapted for the placement of a conduit at a target site on a tissue surface, the device comprising: (a) a hollow conduit guide having a conduit guide distal end, and connected to a conduit guide head at the conduit guide distal end; (b) a conduit extending through the hollow conduit guide and having a conduit distal end portion, the conduit distal end portion extending from the conduit guide head for contact with the tissue surface, and releasably engaging the conduit guide head; (c) an elongated body having a longitudinal axis, a proximal end portion and a distal end portion, and having a proximal inlet and a distal conduit outlet for extending the conduit guide head therethrough for contacting the conduit with the tissue surface, the elongated body comprising (1) a conduit receiving passageway for receiving and conducting the conduit guide head extending between the proximal inlet and the distal conduit outlet therethrough, and (2) a lumen adapted to provide suction to the distal end portion; (d)
  • the conduit may be selected from the group consisting of liquid and gas conduits, such as conductive materials such as wires or fluid-conductive tubules, such conduits adapted to be placed into tissues for electrical or fluid assay, electrical or fluid testing, electrical actuation, or otherwise to bring about electrical or fluid influence or to determine the level of same.
  • conductive materials such as wires or fluid-conductive tubules
  • conduits adapted to be placed into tissues for electrical or fluid assay, electrical or fluid testing, electrical actuation, or otherwise to bring about electrical or fluid influence or to determine the level of same.
  • conduits will include coiled plastic or metal tubules.
  • This device may be provided with a handle portion extending laterally from the elongated body for manual operation, but otherwise may be adapted for robotic use in association with a robotic arm to which it may be readily adapted.
  • this variant may have a flexible attachment of the hollow lead guide to a lead guide head to permit lead insertion action and suction foot swivel about a second axis, such as described herein.
  • This variant of the disclosure may also be used with the hollow conduit guide additionally comprising a flexible member connecting the conduit guide head to the conduit guide distal end.
  • the flexible member in this example and its nature and operation, may be the same or equivalent to that described above with respect to other examples described above.
  • the actuator portion, and its nature and operation may be the same or equivalent to that described above with respect to other examples described above.
  • the source of vacuum suction and its cooperation variants with respect to the fluid communication with the lumen similarly may be the same or equivalent to that described above with respect to other examples described above.
  • a flexible and resilient conduit portion may extend from the distal end of the hollow conduit guide and thereby also serve as a flexible attachment permitting the suction foot to be swiveled while still being of sufficient strength to steer the foot, such that a separate flexible member, such as a spring (as used in the other examples describe herein involving a flexible lead), can be eliminated.
  • a conduit placement device with swiveling suction foot and releasable lead may be adapted for the placement of a conduit at a target site on a tissue surface, the device comprising: (a) a hollow conduit guide; (b) a conduit extending through the hollow conduit guide, the conduit having a conduit distal end portion; (c) an elongated body having a longitudinal axis, a proximal end portion and a distal end portion, and having a proximal inlet and a distal conduit outlet, the elongated body comprising (1) a conduit receiving passageway for receiving and conducting the conduit distal end to the distal conduit outlet, and (2) a lumen adapted to provide suction to the distal end portion; (d) a suction foot portion releasably attached to the conduit distal end portion, and being in fluid communication with the lumen, the suction foot portion swivelably attached to the distal end portion such that the suction foot may be
  • the present disclosure also includes several optional variants including the use of a flexible tip incorporated into the body of the elongated body, such that the device may be adapted for the thoracoscopic placement of a lead at a target site on an epicardial surface of a heart (or the placement of any other conduit into any other type of tissue as described herein)
  • This variant of the device comprises: (a) a hollow lead guide having a lead guide distal end, and connected to a lead guide head at the lead guide distal end; (b) a lead extending through the hollow lead guide and having a lead distal end portion, the lead distal end portion extending from the lead guide head for contact with the epicardial surface of the heart, and releasably engaging the lead guide head; (c) an elongated body having a longitudinal axis, a proximal end portion and a flexible distal end portion, and having a proximal inlet and a distal lead outlet for extending the lead guide head therethrough for contacting the lead with the
  • the flexible distal end portion may include a hinge or may be constructed of a corrugated tube to permit flexion and swiveling motion.
  • the device of the present disclosure may include a suction foot portion that is collapsible and is adapted to be reversibly moved from a stored position within the elongated body to a deployed position outside the elongated body.
  • the collapsible suction foot portion may comprise an array of collapsible fronds adapted to form into a point when in the stored position.
  • the device of the present disclosure may include, on the elongated body, a closure lid adapted to reversibly open and close the distal lead outlet.
  • the device of the present disclosure may include a telescoping portion of the elongated body, so as to be deflectable by the actuator(s).
  • the devices as described herein may additionally comprise a supplementary suction foot portion positioned so as to be capable of retracting tissue, the supplementary suction foot portion additionally comprising cutting means adapted to cut tissue, and being positioned and defining a passageway such that the suction foot portion may pass therethrough.
  • Such a device may have a supplementary suction foot portion that is adapted and configured for pericardiac retraction.
  • the supplementary suction foot portion may comprise two concentrically arranged suction pads, and wherein the cutting means comprises an electrocautery blade disposed between the concentrically arranged suction pads.
  • This method relates to the thoracoscopic placement of a lead at a target site on an epicardial surface of a heart of a non-human animal, the method comprising: (a) extending into the pericardial region a device comprising: a hollow lead guide having a lead guide distal end, and connected to a lead guide head at the lead guide distal end; a lead extending through the hollow lead guide and having a lead distal end portion, the lead distal end portion extending from the lead guide head for contact with the epicardial surface of the heart, and releasably engaging the lead guide head; an elongated body having a longitudinal axis, a proximal end portion and a distal end portion, and having a proximal inlet and a distal lead outlet for extending the lead guide head therethrough for contacting the lead with the epicardial surface of the heart, the elongated body comprising (1) a lead receiving passageway for receiving
  • This methods relates to the thoracoscopic placement of a lead at a target site on an epicardial surface of a heart of a non-human animal, the method comprising:(a) extending into the pericardial region a device comprising: hollow lead guide; a lead extending through the hollow lead guide, the lead having a lead distal end portion; an elongated body having a longitudinal axis, a proximal end portion and a distal end portion, and having a proximal inlet and a distal lead outlet, the elongated body comprising (1) a lead receiving passageway for receiving and conducting the lead distal end to the distal lead outlet, and (2) a lumen adapted to provide suction to the distal end portion; a suction foot portion releasably attached to the lead distal end portion, and being in fluid communication with the lumen, the suction foot portion swivelably attached to the distal end portion such that the
  • This methods relates to the placement of a conduit at a target site on a tissue surface of a non-human animal, the method comprising: (a) extending into the region of the tissue a device comprising: a hollow conduit guide having a conduit guide distal end, and connected to a conduit guide head at the conduit guide distal end; a conduit extending through the hollow conduit guide and having a conduit distal end portion, the conduit distal end portion extending from the conduit guide head for contact with the tissue surface, and releasably engaging the conduit guide head; an elongated body having a longitudinal axis, a proximal end portion and a distal end portion, and having a proximal inlet and a distal conduit outlet for extending the conduit guide head therethrough for contacting the conduit with the tissue surface, the elongated body comprising (1) a conduit receiving passageway for receiving and conducting the conduit guide head extending between the proximal inlet and the distal conduit
  • This methods relates to the placement of a conduit at a target site on a tissue surface of a non-human animal, the method comprising: (a) extending into the region of the tissue a device comprising: a hollow conduit guide; a conduit extending through the hollow conduit guide, the conduit having a conduit distal end portion; an elongated body having a longitudinal axis, a proximal end portion and a distal end portion, and having a proximal inlet and a distal conduit outlet, the elongated body comprising (1) a conduit receiving passageway for receiving and conducting the conduit distal end to the distal conduit outlet, and (2) a lumen adapted to provide suction to the distal end portion; a suction foot portion releasably attached to the conduit distal end portion, and being in fluid communication with the lumen, the suction foot portion swivelably attached to the distal end portion such that the suction foot may be swive
  • the invention also includes a device adapted for the thoracoscopic placement of a lead at a target site on an epicardial surface of a heart, the device comprising: (a) an elongated body having a longitudinal axis, a proximal end portion and a distal end portion, and having a proximal inlet and a distal lead outlet for extending the lead guide head therethrough for contacting the lead with the epicardial surface of the heart, the elongated body comprising (1) a lead receiving passageway for receiving and conducting the lead guide head extending between the proximal inlet and the distal lead outlet therethrough, and (2) a lumen adapted to provide suction to the distal end portion; (b) a suction foot portion in fluid communication with the lumen, the suction foot portion tiltably attached to the distal end portion such that the suction foot may be tilted about two axes with respect to the longitudinal axis; the lead guide head adapted to releasably engage the suction foot portion such that
  • This disclosure also includes variants of the device and method, which are are not according to the invention and are present for illustration purposes only, that may be used for the placement of any similar stimulatory or input lead or injection or extraction conduit at a target site on any organ, tissue or other therapy or diagnostic site, such as where the cardiac lead is replaced by any other physically inserted diagnostic or therapeutic device, such as an electrical lead, tubule or similar longitudinally-extending article that may be guided and placed in a manner similar to that as described with respect to cardiac lead as described herein.
  • diagnostic or therapeutic device such as an electrical lead, tubule or similar longitudinally-extending article that may be guided and placed in a manner similar to that as described with respect to cardiac lead as described herein.
  • the disclosure also includes variant devices adapted for the placement of a longitudinally-extending article at a target site, the device comprising: (a) a hollow longitudinally-extending article guide having an article guide distal end, and connected to a longitudinally-extending article guide head at the longitudinally-extending article guide distal end; (b) a longitudinally-extending article extending through the hollow guide and having a distal end portion, the longitudinally-extending article distal end portion extending from the guide head for contact with the target site, and for releasably engaging the article guide head; (c) an elongated body having a longitudinal axis, a proximal end portion and a distal end portion, and having a proximal inlet and a distal article outlet for extending the article guide head therethrough for contacting the longitudinally-extending article with the target site, the elongated body comprising (1) a longitudinally-extending article receiving passageway for receiving and conducting the longitudinally-extending article guide head extending between the proximal inlet and the
  • the elongated body may also be provided with a handle portion extending laterally therefrom.
  • the hollow longitudinally-extending article guide additionally comprises a flexible member connecting the longitudinally-extending article guide head to the article guide distal end, and the flexible member may be a spring.
  • the device may also include a knob so as to permit the hollow longitudinally-extending article guide to be rotated within the elongated body by hand, so as to rotate the longitudinally-extending article guide head.
  • the flexible member is a spring
  • the suction foot portion upon movement of the hollow longitudinally-extending article guide within the elongated body, the suction foot portion may be tilted about a second of the axes.
  • the suction foot portion may have an engagement aperture aligned with the hollow longitudinally-extending article guide, and wherein the longitudinally-extending article guide head is adapted to releasably engage the engagement aperture.
  • the suction foot portion has an arcuate footprint shape and comprises a plurality of air channels in fluid contact with the lumen, so as to be capable of providing suction to the suction foot portion.
  • the suction foot portion may define an engagement aperture aligned with the hollow longitudinally-extending article guide, and wherein the lead guide head is adapted to releasably engage the engagement aperture.
  • the distal end may be held by the longitudinally-extending article guide head so as to extend from the distal side of the longitudinally-extending article guide head.
  • an interferant release collar may be attached to the longitudinally-extending article distal end portion and disposed on the distal side of the suction foot portion, the interferant release collar being larger than the aperture.
  • the actuator is attached to a knob portion disposed on the proximal end portion, the knob adapted to move the actuator within the elongated body so as to tilt the suction foot about a first of the axes.
  • the actuator may comprise a wire attached to a knob portion disposed on the proximal end portion, the knob adapted to move the actuator within the elongated body so as to tilt the suction foot about a first of the axes.
  • the device may additionally comprising a source of vacuum suction in fluid communication with the lumen, and this lumen may be selected from the group consisting of a hand pump, or a syringe attached to the elongated body, or a motorized pump supplying vacuum suction to the lumen.
  • the device may additionally comprise a test lead extending from the longitudinally-extending article guide head and through the elongated body.
  • Figure 1 is a first side lateral perspective view of a device in accordance with one embodiment of the present invention
  • Figure 2 shows a sectioned first side lateral perspective view of the device 1, taken along line 2 -2 of Figure 1 .
  • Figure 1 shows a device 1 adapted for the thoracoscopic placement of a lead at a target site on an epicardial surface of a heart (that being its principal, but non-exclusive mode of use), the device 1 comprising: (a) a hollow lead guide 2 having a lead guide distal end 3, and connected to a lead guide head 4 at the lead guide distal end 3; (b) a lead 5 extending through the hollow lead guide 2 and having a lead distal end portion 5a, the lead distal end portion 5a extending from the lead guide head 4 for contact with the epicardial surface of the heart, and releasably engaging the lead guide head 4; (c) an elongated body 6 having a longitudinal axis A, a proximal end portion (generally 6a) and a distal end portion (generally 6b), and having a proximal inlet 6c and a distal lead outlet 6d for extending the lead guide head 4 therethrough for contacting the lead 5 with the epicardial surface of the heart.
  • Figure 7 is a second side lateral perspective view of a device 1, and in which like reference numerals refer to corresponding portions thereof.
  • the elongated body 6 comprises (1) a lead receiving passageway (defined in part of elongated body 6) for receiving and conducting the lead guide head 4, and extending between the proximal inlet and the distal lead outlet therethrough; and (2) a lumen 7 adapted to provide suction to the distal end portion thereof.
  • Figure 3 shows a detailed sectioned first side lateral perspective view of the device 1, taken along line 2 -2 of Figure 1 . This view better shows the distal end of the device 1, with suction foot portion 8 is in fluid communication with the lumen 7.
  • FIG. 8 is a detailed upper first side lateral perspective view of the distal end of a device 1, and in which like reference numerals refer to corresponding portions thereof.
  • This Figure shows the distal lead outlet 6d for extending the lead guide head 4 therethrough for contacting the lead 5 with the epicardial surface of the heart.
  • This Figure also shows the appearance of the device 1 with hollow lead guide 2 removed so as to show the lead 5 extending through elongated body portion 6 to reach the lead guide head 4 held in suction foot portion 8 and from which it presents lead distal end portion 5a, with the lead distal end portion 5a extending from the lead guide head 4 for contact with the epicardial surface of the heart.
  • Figure 9 is a more detailed upper first side lateral perspective view of the distal end of a device 1, as shown more generally in Figures 1 and 8 , and in which like reference numerals refer to corresponding portions thereof.
  • This Figure also shows the appearance of the device 1 with hollow lead guide 2 in place as would be seen as it contains lead 5 extending also passing through elongated body portion 6 to reach the lead guide head 4 held in suction foot portion 8 and from which it presents lead distal end portion 5a, with the lead distal end portion 5a extending from the lead guide head 4 for contact with the epicardial surface of the heart.
  • Figure 10 is an even more detailed upper first side lateral perspective view of the distal end of a device 1, as shown more generally in Figures 1 , 8 and 9 , and in which like reference numerals refer to corresponding portions thereof.
  • Figure 4 is a sectioned lateral perspective view of an elongated body portion 6 of the device 1 shown in Figure 2
  • Figure 5 is a detailed sectioned first side lateral perspective view of an elongated body 6, both showing the suction foot portion 8 is in fluid communication with the lumen in greater detail.
  • the lumen 7 typically will comprise a plastic tube, and will typically be sufficiently flexible to permit the suction foot portion 8 to swivel in connection therewith at the distal end.
  • the balance of the lumen 7 may be formed by one or more other lengths of plastic tube, and portions may be comprised by tubular portions of the elongated body 6 itself, as may be appreciated from Figure 5 .
  • the lumen 7 may be served by a source of vacuum as described herein such as at vacuum port 12.
  • the suction foot portion 8 tiltably or swivelably attached to the distal end portion of the elongated body 6 such that the suction foot may be tilted or swiveled about two axes with respect to the longitudinal axis A, to permit the suction foot portion 8 to be positioned for most effective lead placement.
  • This attachment is shown in greater detail in Figures 13 - 23 that describes the example incorporating a spring.
  • the lead guide head 4 is configured so as to be releasably engaged with the suction foot portion 8 such that such engagement is of sufficient strength to maintain the position of the lead distal end 5a portion as it engages the epicardial surface of a heart, and sufficiently releasable such that the lead guide head 4 may be released from the suction foot portion 8 once the lead 5 is attached to the epicardial surface of a heart); and (e) an actuator extending from the proximal end portion to the distal end portion and adapted to tilt the suction foot portion about a first of the axes.
  • the elongated body 6 may be of any length, but typically will have a lead receiving passageway that has a length in the range of 10 cm to 40 cm for manually actuated devices.
  • Robotic adaptation of the present invention may use shorter lengths as well.
  • the elongated body 6 of manually actuated devices be provided with a handle portion 9 extending laterally therefrom for ease of manual use, though it will be appreciated that the invention may be adapted for robotic use without need of a handle.
  • the device be provided with a knob 10 so as to permit the hollow lead guide 2 to be rotated within the elongated body 6 by hand, so as to rotate the lead guide head 4, to permit the user to urge or twist the lead into place, especially where the distal end of the lead wire 5a is in a corkscrew shape as is common.
  • the hollow lead guide additionally and preferably comprises a flexible member connecting the lead guide head to the lead guide distal end, and this flexible member may be any part of sufficient flexibility and resilience to permit the lead guide head and the suction foot 8 to swivel as described herein.
  • the flexible member may be in the form of a metal or plastic spring, or equivalent metal or plastic structure.
  • the flexible member is of sufficient stiffness in the longitudinal direction (such as with a metal spring), that, upon movement of the hollow lead guide 2 within the elongated body 6, the suction foot portion 8 may be tilted or swiveled in a first direction axis.
  • the suction foot portion 8 has an engagement aperture 8a aligned with the hollow lead guide 2, and wherein the lead guide head 4 is adapted to releasably engage with the engagement aperture 8a, such as where the suction foot portion 8 and lead guide head 4 are made of a plastic material, and are sized so as to provide a light mechanical interferences fit that may be released through longitudinal hand force.
  • This releasable engagement may be accomplished by any other means acceptable to the device's use, such as through the use of light magnetic forces or adhesives, as well as through the use of mechanical arrangements involving light interferences fits, that are both of sufficient strength to permit the suction foot 8 to be swiveled into the desired position, while allowing the suction foot 8 and the balance of the device 1 to be pulled free after final lead placement.
  • FIG. 6 is a detailed sectioned proximal end perspective view of an elongated body portion 6 of the device sectioned along the same line 6 - 6 in Fig. 2 , and showing the position of a winding portion integrated near the handle portion 9 about which an actuator, such as a metal wire, may be wound so as to be reciprocally moved within the elongated body portion 6 in accordance with one example.
  • an actuator such as a metal wire
  • the operator may move and swivel the suction foot 8 in different directions through a range of motion that, together with accessory turning of the device 1 itself about its longitudinal axis A, allows the operator to position and orient the suction foot 8 substantially normal to the desired target tissue surface.
  • FIG 11 is an exploded first side lateral perspective view of a device 1, and in which like reference numerals refer to corresponding portions thereof.
  • This Figure shows how the of the hollow lead guide 2 is extended through the elongated body 6 to reach the suction foot portion 8 that may be tilted or swiveled in a first direction axis through its reciprocating movement along the longitudinal axis.
  • the attachment of the lumen acts as a counterbalance to that movement, as well as optionally being the conduit for the actuator that also acts upon the suction foot portion 8 to tilt or swivel it in a second direction.
  • Figure 12 is a lateral perspective view of a lead guide portion of the device shown in Figures 1 and 11 , and in which like reference numerals refer to corresponding portions thereof.
  • Figures 13 - 23 show a more detailed depiction of an example of the distal end of a device 1 of the present invention, and in which like reference numerals refer to corresponding portions thereof.
  • Figure 13 shows a detailed view of the distal end of a device 1.
  • Figure 13 shows the distal end of the elongated body portion 6 which supports and directs hollow lead guide 2 in its reciprocal action along the longitudinal axis of the device as show in earlier Figures.
  • a spring 2a extends reaching to a flange 2b that in turn is attached lead guide head 4.
  • the cardiac lead 5 extends from the end of the hollow lead guide 2 through the spring 2a to reach the lead guide head 4.
  • the lead guide head 4 is attached to the end of the cardiac lead 5a through the use of an additional sleeve portion 4a through which the cardiac lead 5 extends to present corkscrew shape on the distal side of sleeve portion 4a (as seen in subsequent Figures).
  • Figure 13 also shows lumen 7 extending from the distal end of the elongated body portion 6 to a fluid connection with suction foot portion 8. Lumen 7 extends through spring 7a.
  • Springs 2a and 7a thus cooperate to permit suction foot portion 8 to swivel either through motion of the hollow lead guide 2 to which spring 2a is attached or by action of the actuator that extends through lumen 7 (or otherwise) to be able to push against suction foot portion 8 (or physical structure attached thereto), or conversely to pull upon suction foot portion 8 in the opposite direction.
  • suction foot portion 8 may be turned and swiveled to bring it substantially parallel to the intended target plane, and thereby to bring lead distal end 5a substantially normal to the intended target site.
  • Figure 14 is a depiction showing another upper first side lateral perspective view of the distal end of a device 1 of the present invention, and in which like reference numerals refer to corresponding portions thereof.
  • Figure 14 shows the device 1 of the present invention with the hollow lead guide 2 removed to show more clearly the elongated body portion distal outlet 6(d) and the lateral port 6(e).
  • the actuator 13 extending lumen 7 which, by reciprocating motion in connection with suction foot portion 8, brings about the tilting of suction foot portion 8.
  • Figure 15 is a depiction showing another upper first side lateral and distal end perspective view of the distal end of an elongated body portion and suction head of the device 1 of the present invention, and in which like reference numerals refer to corresponding portions thereof.
  • Figure 15 shows a more complete perspective view of the device shown in Figure 14 and wherein the relative position of the elongated body portion 6, its handle 9, actuator knob 11 and vacuum port 12 can be appreciated.
  • This view also shows elongated body portion distal opening 6(d), as well as lumen 7 extending from the elongated body portion 6 and containing actuator 13 while being swivelably supported by spring 7a.
  • Figure 16 is a depiction showing another upper first side lateral and distal end perspective view of the distal end of a lead guide portion of the device 1 of the present invention, and in which like reference numerals refer to corresponding portions thereof.
  • Figure 16 is a depiction of the hollow lead guide 2 from which extends spring 2a to optional sleeve portion 2b.
  • the optional sleeve portion 2b or other portion of the lead guide head 4 may be used to engage the suction foot portion 8, in this case between the legs of its horseshoe shape.
  • This view further shows spring 2a in connection with lead guide head 4 which in turn releasably supports sleeve 4a into which lead 5 is connected.
  • This view shows that, once lead distal end 5a is placed into the tissue such as through a turning of knob 10, the lead remains in place with sleeve portion 4a, while allowing the guide head 4 to be withdrawn along with the balance of the lead guide structure.
  • Figures 17 and 18 are depictions showing a first side lateral view of the distal end of a lead guide portion of the device 1 of the present invention, and in which like reference numerals refer to corresponding portions thereof.
  • Figure 19 is a depiction showing a distal end perspective view of the distal end of a lead guide portion of the device 1 of the present invention, and in which like reference numerals refer to corresponding portions thereof.
  • Figure 20 is a depiction showing a first side lateral view of the distal end of a lead guide portion of the device 1 of the present invention, and in which like reference numerals refer to corresponding portions thereof.
  • Figure 20 shows the lead guide portion of the device with the lead 5, sleeve 4a and lead distal end 5a disengaged from lead guide head 4 and the balance of the lead guide portion, as would occur as the lead guide portion is withdrawn from the target area after placement of the lead distal end 5a, such as by withdrawing it along longitudinal axis A.
  • Figure 21 is a depiction showing a distal end perspective view of the distal end of a lead guide portion and suction head of the device 1 of the present invention, and in which like reference numerals refer to corresponding portions thereof.
  • Figure 21 shows a detailed distal end perspective view of the device 1, and shows how lead guide head 4 may be configured so as to fit into a corresponding structure in suction foot 8 to allow suction foot 8 to be swiveled by action of the hollow lead guide 2, while also being adapted to permit sleeve 4a to disengage from lead guide head 4 to allow the suction foot and associated lead guide head to disengage from the sleeve 4a and the lead distal end 5a once the lead is placed.
  • Figure 22 is a depiction showing an upper first side lateral perspective view of the distal end of a device 1 of the present invention, and in which like reference numerals refer to corresponding portions thereof.
  • Figure 22 shows still another view of the distal end of the device 1 following displacement of the lead 5 having been drawn substantially along longitudinal axis A.
  • Figure 23 is a depiction showing another upper first side lateral perspective view of the distal end of a device 1 of the present invention, and in which like reference numerals refer to corresponding portions thereof.
  • Figure 23 shows an end view of the device 1 of the present invention and showing the distal end of the device as it would appear following displacement of the lead and withdrawal of the balance of the device from the target site.
  • the hollow lead guide 2 is placed into and through the elongated body portion 6, and this may be facilitated by guiding the hollow lead guide 2 bearing spring 2a, optional sleeve portion 2b and lead guide head 4 through the elongated body portion 6, which access may be facilitated by use of optional port 6e.
  • the distal end of the hollow lead guide 2 i.e., the lead guide head 4 and/or optional sleeve portion 2b, are seated in the suction foot portion 8 so as to permit the lead 5 it will guide to extend beyond the plane defined by the contact side of the suction foot portion 8).
  • the lead 5 may then be affixed into the lead guide head by extending the lead 5 into the lead guide head until sleeve 4a releasably engages into lead guide head 4.
  • a source of suction such as a 10 cc or 20 cc syringe may be affixed to vacuum port 12.
  • This mode of construction is preferred where the surgeon desires to be free of any tether to wall-mounted vacuum ports.
  • the distal end of the device 1 is inserted into the patient directed toward the target site.
  • the suction foot portion 8 typically is in a position such that the contact plane is substantially perpendicular to the longitudinal axis of the device.
  • the contact plane of the suction foot portion 8 will deflect in respective alternate directions with respect to the vertical (i.e., in this example with respect to the axis defined by the handle portion 9).
  • suction may be applied to the suction foot portion 8 by use of a syringe attached to vacuum port 12. This causes the suction foot portion 8 be firmly attached to the target site.
  • the lead may be fixed by turning knob 10 in order to cause the corkscrew-shaped lead terminal end 5a to be inserted into the tissue.
  • the hollow lead guide portion 2 is withdrawn toward the proximal and 6a of the elongated body portion 6.

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Claims (9)

  1. Dispositif (1) adapté pour le placement d'une dérivation au niveau d'un site cible sur une surface de tissu, le dispositif comprenant :
    (a) un guide-dérivation creux (2) ayant une extrémité distale de guide-dérivation (3), et relié à une tête de guide-dérivation (4) au niveau de ladite extrémité distale de guide-dérivation (3) ;
    (b) une dérivation (5) s'étendant à travers ledit guide-dérivation creux (2) et ayant une partie extrémité distale de dérivation (5a), ladite partie extrémité distale de dérivation (5a) s'étendant à partir de ladite tête de guide-dérivation (4) pour venir au contact de la surface de tissu, et se mettant en prise libérable avec ladite tête de guide-dérivation (4) ;
    (c) un corps allongé (6) ayant un axe longitudinal (A), une partie extrémité proximale (6a) et une partie extrémité distale (6b), et ayant une entrée proximale (6c) et une sortie de dérivation distale (6d) pour étendre ladite tête de guide-dérivation (4) à travers celui-ci pour mettre ladite dérivation (5) en contact avec la surface de tissu, ledit corps allongé (6) comprenant (1) un passage de réception de dérivation pour recevoir et conduire ladite tête de guide-dérivation s'étendant entre ladite entrée proximale (6c) et ladite sortie de dérivation distale (6d) à travers celui-ci, et (2) une lumière (7) adaptée à fournir une aspiration à ladite partie extrémité distale (6b) ;
    (d) une partie pied-ventouse (8) en communication fluidique avec ladite lumière (7), ladite partie pied-ventouse (8) fixée de manière inclinable à ladite partie extrémité distale (6b) de telle sorte que ledit pied-ventouse (8) peut être incliné autour de deux axes par rapport audit axe longitudinal (A) ;
    ladite tête de guide-dérivation (4) adaptée à se mettre en prise de manière libérable avec ladite partie pied-ventouse (8) de telle sorte que la mise en prise est d'une résistance suffisante pour maintenir la position de ladite partie extrémité distale de dérivation (5a) alors qu'elle se met en prise avec ladite surface de tissu, et suffisamment libérable de telle sorte que ladite tête de guide-dérivation (4) peut être libérée de ladite partie pied-ventouse (8) une fois que ladite dérivation (5) est fixée à ladite surface de tissu ; et
    (e) un actionneur (13) s'étendant à partir de ladite partie extrémité proximale (6a) jusqu'à ladite partie extrémité distale (6b) et adapté à incliner ladite partie pied-ventouse (8) autour d'un premier des desdits axes.
  2. Dispositif selon la revendication 1 dans lequel ledit corps allongé présente une partie poignée s'étendant latéralement à partir de celui-ci.
  3. Dispositif selon la revendication 1 ou 2 dans lequel ledit guide-dérivation creux comprend en outre un élément flexible raccordant ladite tête de guide-dérivation à ladite extrémité distale de guide-dérivation.
  4. Dispositif selon les revendications 1 à 3 comprenant en outre un bouton configuré pour permettre la rotation manuelle dudit guide-dérivation creux à l'intérieur dudit corps allongé, configuré pour entraîner en rotation ladite tête de guide-dérivation.
  5. Dispositif selon la revendication 3 dans lequel l'élément flexible est un ressort et dans lequel, sous l'effet du mouvement dudit guide-dérivation creux à l'intérieur dudit corps allongé, ladite partie pied-ventouse peut être inclinée autour d'un second desdits axes.
  6. Dispositif selon les revendications 1 à 5 dans lequel ladite partie pied-ventouse présente une ouverture de mise en prise alignée avec ledit guide-dérivation creux, et dans lequel ladite tête de guide-dérivation est adaptée à se mettre en prise de manière libérable avec ladite ouverture de mise en prise.
  7. Dispositif selon les revendications 1 à 6 dans lequel la partie pied-ventouse présente une forme d'empreinte de pas arquée et comprend une pluralité de canaux d'air en contact fluidique avec ladite lumière, configurés pour être capables de fournir une aspiration à ladite partie pied-ventouse.
  8. Dispositif selon la revendication 1 dans lequel ledit actionneur comprend un élément flexible reliant ladite partie pied-ventouse audit corps allongé.
  9. Dispositif selon la revendication 1 dans lequel ladite partie pied-ventouse est fixée de manière libérable à ladite partie extrémité distale de dérivation, ladite partie pied-ventouse fixée de manière pivotante à ladite partie extrémité distale de telle sorte que ledit pied-ventouse peut pivoter par rapport audit axe longitudinal, et ;
    ladite dérivation adaptée à se mettre en prise libérable avec ladite partie pied-ventouse de telle sorte qu'une telle mise en prise est d'une résistance suffisante pour maintenir la position de ladite partie extrémité distale de dérivation alors qu'elle se met en prise avec ladite surface de tissu, et suffisamment libérable de telle sorte que ladite dérivation peut être libérée de ladite partie pied-ventouse une fois que ladite dérivation est fixée à ladite surface de tissu ; et
    dans lequel ledit actionneur est adapté à incliner ladite partie pied-ventouse autour d'un premier axe par rapport audit axe longitudinal ; et
    dans lequel ledit guide-dérivation creux est adapté à incliner ladite partie pied-ventouse autour d'un second axe par rapport audit axe longitudinal.
EP16905653.8A 2016-06-16 2016-06-16 Dispositif et méthode de placement de conducteurs et de conduits Active EP3471819B1 (fr)

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/US2016/037864 WO2017217996A1 (fr) 2016-06-16 2016-06-16 Dispositif et méthode de placement de conducteurs et de conduits

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EP3471819A1 EP3471819A1 (fr) 2019-04-24
EP3471819A4 EP3471819A4 (fr) 2020-02-12
EP3471819B1 true EP3471819B1 (fr) 2021-07-21

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CN115300768A (zh) * 2022-08-19 2022-11-08 上海暖阳医疗器械有限公司 一种具有可释放头端的导管

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Publication number Priority date Publication date Assignee Title
US20030187461A1 (en) * 1999-08-10 2003-10-02 Chin Albert K. Releasable guide and method for endoscopic cardiac lead placement
US7146225B2 (en) * 2002-10-30 2006-12-05 Medtronic, Inc. Methods and apparatus for accessing and stabilizing an area of the heart
US7544197B2 (en) * 2003-05-06 2009-06-09 Greatbatch Ltd. Rotatable lead introducer
US20070185502A1 (en) * 2005-12-29 2007-08-09 Karel Smits Medical electrode delivery tool
US7801622B2 (en) * 2006-03-30 2010-09-21 Medtronic, Inc. Medical electrical lead and delivery system
US9370655B1 (en) * 2013-03-07 2016-06-21 Subhajit Datta Lead and conduit placement device and method

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EP3471819A1 (fr) 2019-04-24
EP3471819A4 (fr) 2020-02-12

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